Research manuals in neonatal care, such as the Manual of Neonatal Care, tackle newborn conditions, the effects of maternal drugs on the fetus, and assessment and treatment in the immediate postnatal period. Worldwide, nearly half of the deaths in children under age 5 are newborns. Therefore, high-risk newborns must receive additional attention before, during, and immediately after birth.
High-risk newborns are typically associated with specific fetal, maternal, or placental conditions. When at least one of these conditions is present, nursery staff must be prepared for possible difficulties.
One of the associated risks for the fetus is the age of the mother at delivery. Newborns from mothers under 16 years have a higher risk of intrauterine growth retardation (IUGR) and prematurity. Neonates from mothers over 40 have a higher risk of blood loss, chromosomal abnormalities, IUGR, and macrosomia, meaning they are much larger than average. Additionally, mothers with certain medical conditions may present complications. If they have renal disease, heart disease, lung disease, hypertension, or anemia, they have a higher risk of giving birth to a premature or stillborn child.
Some fetal characteristics and associated risks for neonates are multiple gestations, which can result in birth trauma, twin-twin transfusion syndrome (when there is a disproportion in the blood exchange between twins or multiples), and prematurity; and abnormal fetal position or presentation, a factor that may result in hemorrhage, congenital anomalies, and birth trauma. Polyhydramnios, or the excessive accumulation of amniotic fluid, may also cause complications such as central nervous system disorders, neuromuscular disorders, diaphragmatic hernia, and swallowing problems.
If labor and delivery conditions are unnatural, the nursery staff must be prepared for possible risks. For instance, if the mother presents fever during childbirth, the neonate has a higher risk of sepsis, which affects the bloodstream and may cause death. In addition, issues may arise with preterm delivery and post-term delivery, or delivery occurring more than two weeks after the term. Post-term delivery has higher chances of asphyxia, stillbirth, and meconium aspiration (the baby breathing in its feces in the amniotic fluid).
Other labor and delivery conditions that present a higher risk of complication for fetuses and newborns include rapid or prolonged labor, prolapsed cord, cesarean section, and placental anomalies such as a torn placenta, one that is excessively small, or one that is excessively large. Immediately evident neonatal conditions and associated risks include prematurity, which may result in respiratory distress syndrome and other sequelae, or conditions that occur due to another condition; a foul smell of membranes or amniotic fluid, which may indicate infection; and small size for the gestational age.
As a rule, at least one healthcare provider trained in neonatal resuscitation must be physically available during birth, no matter the risk status. However, if a healthcare provider anticipates a high-risk delivery due to factors identified before birth, advanced neonatal resuscitation is crucial - at least two healthcare providers should be available to manage the baby. Furthermore, the nursery staff must have a resuscitation team for high-risk gestations, each member with a specific, predetermined role.
Finally, a healthcare provider should save the placenta after delivery. With the help of placental pathology, doctors can diagnose difficult conditions, such as toxoplasmosis, an infectious disease with flu-like symptoms caused by a parasite.
